Digoxin: Price, Dosage & Where to Buy

Digoxin is a cardiac medicine in the cardiac glycoside group, also available as a generic medicine. It is most commonly prescribed for adults with mild to moderate heart failure or to help control the resting ventricular rate in chronic atrial fibrillation. It requires a prescription in the United Kingdom and is available as tablets, oral solution and injectable medicine.

Digoxin is indicated for mild to moderate heart failure in adults. It can improve the heart's pumping function and heart failure symptoms, including exercise capacity, and may reduce heart failure-related hospital and emergency care use, although it does not affect mortality. Where possible, adult heart failure treatment uses digoxin with a diuretic and an angiotensin-converting enzyme inhibitor.

In children with heart failure, digoxin can increase the force of the heart's contraction. In adults with chronic atrial fibrillation, it is used to control the ventricular response rate.

Digoxin treatment in children requires careful individual assessment. The safety and effectiveness of digoxin for controlling ventricular rate in children with atrial fibrillation have not been established.

Digoxin is a cardiac glycoside. It increases the force of contraction of heart muscle, which can help the heart pump blood more effectively in some people with heart failure. It also increases parasympathetic activity and slows electrical conduction through the atrioventricular node.

This slowing effect can reduce how quickly signals pass from the atria to the ventricles. In chronic atrial fibrillation, that action can help control the ventricular response rate.

Digoxin also affects the heart's electrical excitability, which is why its effects and blood concentration require careful monitoring. The difference between a helpful concentration and a toxic concentration can be small, particularly when kidney function, body weight, age, electrolyte levels or other medicines affect digoxin levels.

The label lists tablets containing 0.0625 mg, 0.125 mg and 0.25 mg, as well as 125 micrograms and 250 micrograms. The label lists oral solution containing 0.05 mg/mL. The label lists injections containing 0.25 mg/mL, 100 micrograms/mL and 250 micrograms/mL.

The label lists oral loading doses of 20 to 45 micrograms/kg for children aged 5 to 10 years and 10 to 15 micrograms/kg for adults and children over 10 years. The label lists maintenance dosing based on lean body weight, kidney function, age and other medicines. The label lists a starting maintenance dose of 3.4 to 5.1 micrograms/kg/day, given once daily, for adults and children over 10 years with normal kidney function.

The label lists 3.2 to 6.4 micrograms/kg/dose, given twice daily, for children aged 5 to 10 years. Monitoring for treatment effect and toxicity is required.

A missed digoxin dose can reduce the medicine's effect, but taking extra medicine can increase the risk of toxicity because digoxin has a narrow therapeutic index. General pharmacy practice is to seek advice from a pharmacist or prescriber about the missed dose, particularly if more than one dose has been missed.

A missed dose should not be replaced with an extra dose unless specifically advised. Urgent medical help is needed for suspected toxicity, especially nausea, vomiting, visual changes or an abnormal heartbeat.

Published experience over several decades has not identified a digoxin-associated risk of major birth defects, miscarriage or adverse maternal and fetal outcomes, although animal reproduction studies have not been conducted. Digoxin crosses the placenta, and newborn babies should be monitored for toxicity, including vomiting and cardiac arrhythmias. Digoxin requirements may increase during pregnancy and decrease after delivery, so serum levels are monitored during pregnancy and the postpartum period.

The label states that the amount received through breastfeeding is up to 4% of the neonatal maintenance dose and is unlikely to be clinically relevant. There are no data on effects in the breastfed infant or on milk production. Discuss pregnancy or breastfeeding with a doctor or pharmacist.

Store tablets in a dry place at 20 to 25 degrees Celsius and protect them from light. Keep digoxin out of reach of children and in a tight, light-resistant container with a child-resistant closure, as directed on the label. Follow the product label for storage of oral solution or injection.